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Barriers and facilitators to pharmacotherapy for alcohol use disorders in primary care: results of a qualitative study in 4 va primary care clinics
Addiction Science & Clinical Practice volume 10, Article number: P12 (2015)
In the context of routine population-based alcohol screening to identify primary care (PC) patients who might benefit from brief intervention, many patients identified will have alcohol use disorders (AUD) and will likely require more intensive treatments. FDA approved medications are recommended to treat AUDb and could be offered in PC. Currently, use of AUD medications is extremely rare. This qualitative study sought to understand barriers and facilitators to prescribing AUD medications in PC.
Material and methods
Key contacts and snowball sampling were used to recruit 23 PC providers (MDs and NPs) from 4 Veterans Health Administration (VA) clinics. Providers completed semi-structured interviews in person, which were recorded, transcribed, and analyzed using rapid team-based qualitative methods.
Few participating providers had prescribed AUD medications. Providers consistently reported concern regarding lack of time to adequately address AUD, need for training in prescribing AUD medications, and need for ongoing support from mental health or on-site staff to provide behavioral counseling. However, some participating providers were more willing than others to consider prescribing AUD medications. Providers who were more willing viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective “tool” or “foot in the door” for treating AUD, and believed that providing AUD medications in PC may catalyze change while reducing stigma and other barriers to specialty addictions treatment. Those who were less willing believed that substantial programmatic changes would be needed to facilitate provision of AUD medications in PC, had less belief in the ability of “pills” to treat AUD, and believed AUD treatment was best left to specialty settings.
With training and additional behavioral staff, it may be possible to capitalize on some providers' willingness and optimism to increase provision of medications as part of PC for patients with AUD.
Williams EC, Rubinsky AD, Lapham GT, Hawkins EJ, Chavez LJ, Rittmueller SE, Hawkins EJ, Grossbard J, Kivlahan DR, Bradley KA: Prevalence of Recognized Alcohol and Other Substance Use Disorders among VA Outpatients with Unhealthy Alcohol Use Identified by Routine Alcohol Screening. Drug and Alcohol Dependence. 2014, 135: 95-103.
NIAAA: Helping Patients Who Drink Too Much: A Clinician's Guide (Updated 2005 Edition). 2007, Washington, D.C.: NIH, US DHHS
Harris AH, Kivlahan DR, Bowe T, et al: Pharmacotherapy of alcohol use disorders in the Veterans Health Administration. Psychiatr Serv. 2010, 61: 392-8. 10.1176/ps.2010.61.4.392.
The authors gratefully acknowledge the participants of this study for allowing us to solicit and report on their perspectives. We also thank the clinical and administrative coordinators at each of the clinics for facilitating our visits. This study was funded by VA Health Services Research & Development and VA Quality Enhancement Research Initiative (RRP 12-528; Williams PI). Dr. Williams is supported by a Career Development Award from VA Health Services Research & Development (CDA 12-276). Dr. Bradley's time on this study was supported by the Center of Excellence for Substance Abuse Treatment and Education (CESATE) at VA Puget Sound.
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Cite this article
Williams, E., Achtmeyer, C., Young, J. et al. Barriers and facilitators to pharmacotherapy for alcohol use disorders in primary care: results of a qualitative study in 4 va primary care clinics. Addict Sci Clin Pract 10, P12 (2015) doi:10.1186/1940-0640-10-S2-P12
- Primary Care
- Qualitative Study
- Primary Care Provider
- Veteran Health Administration
- Primary Care Clinic